Priority for Taxonomy Code Usage for Claims

File Maintenance Help for NextGen® Enterprise 8

Examples of Payer Taxonomy Setup

The following table contains examples of split claims and descriptions of which taxonomy code is used based on whether the payer is the main or the alternate and where the codes exist in File Maintenance. The most specific setting is always selected instead of the other settings. Claims Used for: Main Payer/ Alt Payer Descriptions of Which Taxonomy Code Is Used 1500/1500 The main payer claims pull the taxonomy code from the Group master file. When the taxonomy code is attached to the alternate payer, the code overrides the group taxonomy in the Group master file in the 837 Professional 2000A loop PRV segment for all Alternate Payer claims for the specific location for the payer. If the Alternate Payer Taxonomy Code field is blank, the claim pulls the taxonomy code from the Group master file for alternate payer claims. UB/1500 When the taxonomy code is attached to the enhanced UB tab for a specific location for the main Payer, the taxonomy code overrides the group taxonomy in the Group

File Maintenance Help for NextGen® Enterprise 8

Attaching a Taxonomy Code to the Alternate Payer

From the Master Files list, select System or PM > Payers. Select the payer. Select the Alt Payer tab. In the Location Specific Information section, select the taxonomy code from the Taxonomy Code field. Parent topic: Taxonomy Codes to Payers

File Maintenance Help for NextGen® Enterprise 8

Attaching Taxonomy Codes to Payers

You can attach a taxonomy codes to payers at the Practice level. To attach a taxonomy code to the payer at the practice level: From the Master Files list, select System or PM > Payers. Select the payer. Select the Practice tab, and then select the UB subtab. Select a service location from the Location field, and then select the taxonomy code from the Taxonomy Code field. Repeat the previous step for each applicable location. Select OK. Parent topic: Taxonomy Codes to Payers

File Maintenance Help for NextGen® Enterprise 8

Taxonomy Codes to Payers

You can attach taxonomy codes for group billing in the Payer master file. These codes override the Group master file taxonomy code. You can attach these codes to: Payers at the practice level for specific locations. This setting is only for UB claims. Alternate payers for a specific location. Attaching Taxonomy Codes to Payers Attaching a Taxonomy Code to the Alternate Payer Priority for Taxonomy Code Usage for Claims Examples of Payer Taxonomy Setup Parent topic: Taxonomy Codes

File Maintenance Help for NextGen® Enterprise 8

Set Up an Alternate CPT4 Code

Open a Service Item library. From the Search list on the left, select a service item and then select the Payer tab. Select the applicable main payer from the drop-down list. Enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 column. Note: If there is an alternate payer attached to a main payer in the Payer Master and there are Alternate Payer Alternate CPT4 codes that need to be used on the alternate payer claim, then enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 field for the selected service item and payer that the alternate payer is attached to. Only when the location and service items on the encounter match the location and services set up on the Alternate Payer tab of the Add/Modify Payer Information window for the main payer will Alternate Payer Alternate CPT4 codes populate to the alternate payer claim. Parent topic: Alternate CPT4 Code

File Maintenance Help for NextGen® Enterprise 8

Attaching Taxonomy Codes to Groups

From the Master Files list, select Practice > Groups. Select the group. If you want to select a default taxonomy code for the group, select a code from the Taxonomy Code field. A taxonomy code added to the default location with a specific payer row applies only for that payer across all locations. The code overrides the taxonomy code at the top of the group screen for that payer. If you want to select a taxonomy code for the group at the location level: Select a service location. Then double-click a payer name in the Payer column. And then select the code from the Taxonomy Code field. A taxonomy code added to the default payer row at a specific location applies for all payers at that location. The code can also be payer-specific at a specific location. The most specific setting is always selected above the other settings. If you want to set taxonomy codes for specific procedure ranges, select the CPT4 Group Information button. The CPT4 Group Information for [Group Name] window displays

Priority for Taxonomy Code Usage for Claims

Recommendations

Examples of Payer Taxonomy Setup

Attaching a Taxonomy Code to the Alternate Payer

Attaching Taxonomy Codes to Payers

Taxonomy Codes to Payers

Set Up an Alternate CPT4 Code

Attaching Taxonomy Codes to Groups

Examples of Payer Taxonomy Setup

Attaching a Taxonomy Code to the Alternate Payer

Attaching Taxonomy Codes to Payers

Taxonomy Codes to Payers

Set Up an Alternate CPT4 Code

Attaching Taxonomy Codes to Groups